Organization
GREAT PLAINS OF REPUBLIC CO., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID-PAUL CAVAZOS (ADMINISTRATOR)
(785) 527-6000
Entity
Organization
Contact information
Practice address
2420 G ST, BELLEVILLE, KS 66935-2400
(785) 527-2254
(785) 527-2501
Mailing address
2420 G ST, BELLEVILLE, KS 66935-2400
(785) 527-2254
(785) 527-2501
Taxonomy
Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
Primary
HO79001
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001586
KANSAS BLUE CROSS
KS
05
—
100409140A
—
KS
Enumeration date
07/26/2006
Last updated
05/14/2025
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